Paeonia lactiflora Pall.

Peony/Drug Interactions:

  • Antiangiogenic drugsAntiangiogenic drugs: Theoretically, peony may increase the effects of antiangiogenic agents (31).
  • Antineoplastic agentsAntineoplastic agents: A dose of 15g daily of Ninjin Yoei To (NYT; Ren-Shen-Yang-Rong-Tang (Chinese), Kotaro Pharmaceutical Co., Ltd., Osaka, Japan) was administered to an elderly patient with lung carcinoma and after seven weeks, there was a decrease in CEA and CA19-9 (tumor marker) levels (32).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Wong et al. reported a case of easy gum bleeding, epistaxis, and skin bruising with an international normalized ratio (INR) >6.0 in a 61 year-old man who was previously stable on warfarin therapy (27).
  • AntihypertensivesAntihypertensives: Treatment effects of Angelica and Paeonia powder on gestational hypertension syndrome have been observed (30).
  • Anti-inflammatory agentsAnti-inflammatory agents: Anti-inflammatory effects of peony have been observed in laboratory studies (2; 33; 4).
  • Antilipemic agentsAntilipemic agents: Dandi Tablet (DDT), a traditional Chinese medicine formula including prepared Rehmannia root 24g, dogwood fruit 9g, Poria 9g, water-plantain 9g, tuber peony bark 9g, Chinese yam 12g, and red sage 15g, has been shown to significantly decrease the total cholesterol (TC) to HDL cholesterol (HDL-C) ratio in postmenopausal women (13). This formula also significantly increased HDL-C levels in these women.
  • Antiretroviral agentsAntiretroviral agents: The methanol extract of Paeonia suffruticosa has demonstrated strong inhibition of HIV-I integrase activity in vitro and may be a rich source of anti-HIV compounds (21).
  • Antiviral agentsAntiviral agents: Antiviral effects have been observed in vitro (18; 21; 20).
  • Hormonal agentsHormonal agents: Based on in vitro and human data, combination products containing peony may interact with hormonal agents (5; 28; 13).
  • ImmunosuppressantsImmunosuppressants: A Chinese herbal medicine (containing Astragalus membranaceus, Atractylodes macrocephala, Paeonia lactiflora, Taraxacum monogolicum, and Oldenlandia diffusa) has been used to treat Campylobacter pyloridis (CP) infections. Researchers propose that this herbal combination may modulate immune function (26).
  • Phenytoin (Dilantin?)Phenytoin (Dilantin?): Based on secondary sources, peony root may theoretically delay the absorption of phenytoin, reducing its therapeutic effectiveness.
  • SteroidsSteroids: Patients taking the herbal formula Qingre Huoxue recipe (QHR, decoction of oldenlandia herb 30g, honeysuckle stem 30g, violet herb 30g, red peony root 15g, rehmannia root 15g, solomonseal rhizome 15g, asiabell root 30g, red sage root 30g, prepared rhubarb 12g, and giant-hyssop herb 12g) once daily in conjunction with pharmaceutical drugs for the treatment of mid-advanced crescentic nephritis used significantly less glucocorticoid medication (vs. the control group taking drugs only) after three months of treatment (6).
  • TamoxifenTamoxifen: Tamoxifen has been shown to block the activation of the chimeric estrogen receptor by Bupleurum & Peony formula (Jia Wei Xiao Yao San) in vitro (24). Theoretically, Tamoxifen may interfere with the physiological effects of this formula if administered concomitantly.
  • VasodilatorsVasodilators: Based on in vitro study, PGG, a constituent of peony root, dilates vascular smooth muscle and suppresses the vascular inflammatory process via endothelium-dependent nitric oxide (NO)/cGMP signaling (17).

    • Peony/Herb/Supplement Interactions:

  • Antiangiogenic herbs and supplementsAntiangiogenic herbs and supplements: Based on laboratory study, peony may increase the effects of antiangiogenic agents (31).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Wong et al. reported a case of easy gum bleeding, epistaxis, and skin bruising with an international normalized ratio (INR) >6.0 in a 61 year-old man who was previously stable on warfarin therapy (27).
  • Anti-inflammatory herbs and supplementsAnti-inflammatory herbs and supplements: Peony has exhibited anti-inflammatory activity in multiple laboratory studies (2; 33; 34; 17; 4).
  • AntilipemicsAntilipemics: A combination product called Dandi Tablet (DDT), which contains peony and other herbs, has been shown to significantly decrease the total cholesterol (TC) to HDL cholesterol (HDL-C) ratio and significantly increase HDL-C levels in postmenopausal women (13).
  • AntioxidantsAntioxidants: Traditional Chinese herbal formulas containing peony have demonstrated antioxidant activity in vitro (14; 23; 7).
  • AntiviralsAntivirals: Peony has exbitied anti-HIV and anti-HBV effects in vitro (18; 21; 20).
  • Ferulic acidFerulic acid: Peony has been deomnostrated to significantly lower the clinical bioavailability of ferulic acid derived from Ligusticum walichii (35).
  • Hormonal herbs and supplementsHormonal herbs and supplements: Based on in vitro and human study with peony containing combination products, peony may interact with hormonal agents (5; 28; 13).
  • HypotensivesHypotensives: Guo et al. offered clinical observations on the treatment of gestational hypertension syndrome with Angelica and Paeonia powder (30).
  • ImmunostimulantsImmunostimulants: Laboratory and human study of peony combination products suggest that peony may modulate immune function (22; 26).
  • SteroidsSteroids: Based on human study, a combination product including peony may decrease the need for glucocorticoid medication in some patients with nephritis (6).
  • Vasodilator herbs and supplementsVasodilator herbs and supplements: Based on in vitro study, peony may increase the effects of vasodilators (17).

    • Peony/Food Interactions:

  • Ferulic acidFerulic acid: Huang et al. reported the effects of Ligusticum walichii and Paeonia veitchi on the bioavailability of ferulic acid (35).

    • Peony/Lab Interactions:

  • Apo-A levelsApo-A levels: Dandi Tablet (DDT), a traditional Chinese medicine formula including prepared Rehmannia root 24g, dogwood fruit 9g, Poria 9g, water-plantain 9g, tuber peony bark 9g, Chinese yam 12g, and red sage 15g, has been shown to significantly increase APO-a levels in postmenopausal women (13).
  • Basal body temperatureBasal body temperature: In a case series trial with 20 young Japanese women, Toki-shakuyaku-san, a traditional Chinese herbal prescription (consisting of peony root, atractylodes lancea rhizome, alisma rhizome, hoelen, cnidium rhizome, and Japanese angelica root) has been shown to improve low luteal phase basal body temperature (5).
  • Blood and plasma viscosityBlood and plasma viscosity: In clinical study, both intravenous injection and pulmonary artery injection of 100% Paeonia lactiflora 5mL has resulted in statistically significant improvements in blood and plasma viscosity (11).
  • CA19-9CA19-9: A dose of 15g daily of Ninjin Yoei To (NYT; Ren-Shen-Yang-Rong-Tang (Chinese), Kotaro Pharmaceutical Co., Ltd., Osaka, Japan), was administered to an elderly patient with lung carcinoma and after seven weeks, there was a decrease in CEA and CA19-9 (tumor marker) levels (32).
  • CA-125CA-125: When women with symptomatic uterine myomas were treated with Kuei-chih-fu-ling-wan (Keishi-bukuryo-gan; KBG), a traditional Chinese herbal remedy, CA-125 scores tended to decrease with the decrease in size of myomas (8).
  • CEACEA: A dose of 15g daily of Ninjin Yoei To (NYT; Ren-Shen-Yang-Rong-Tang (Chinese), Kotaro Pharmaceutical Co., Ltd., Osaka, Japan) was administered to one elderly patient with lung carcinoma (32). After seven weeks, there was a decrease in the patient's CEA and CA19-9 (tumor marker) levels.
  • Cholesterol levelsCholesterol levels: Dandi Tablet (DDT), a traditional Chinese medicine (TCM) formula including prepared rehmannia root 24g, dogwood fruit 9g, Poria 9g, water-plantain 9g, tuber peony bark 9g, Chinese yam 12g, and red sage 15g, has been shown to significantly decrease the total cholesterol (TC) to HDL cholesterol (HDL-C) ratio in postmenopausal women (13). This formula also significantly increased HDL-C levels in these women.
  • Erythrocyte superoxide dismutase (ESOD)Erythrocyte superoxide dismutase (ESOD): Administration of "Huayu decoction" (HYD), (consisting of Angelica sinensis, Paeonia lactiflora, Ligusticum wallichii, Spathollobus suberectus, Hirudo nipponica, Tabanus bivittatus, Paeonia suffruticosa, and Astragalus membranaceus) to infantile pneumonia patients has resulted in reduced ESOD activity during the acute stage with a return to normal levels during convalescence (7).
  • Estrogen levelsEstrogen levels: Dandi Tablet (DDT), a traditional Chinese medicine (TCM) formula including prepared rehmannia root 24g, dogwood fruit 9g, Poria 9g, water-plantain 9g, tuber peony bark 9g, Chinese yam 12g, and red sage 15g, has been shown to significantly increase (estradiol) E2 levels in postmenopausal women (13). Bupleurum & Peony Formula (Jia Wei Xiao Yao San) has been shown to activate the chimeric estrogen receptor in vitro (24). Unkei-to (a traditional Japanese herbal medicine consisting of Shakuyaku (Paeonia radix, Paeonia lactiflora Pallas) and Keihi (Cinnamomi cortex, Cinnamomum cassia Blume) has been shown to have stimulatory effects on the ovulatory process and the hypothalamic-pituitary axis in human granulosa cells in vitro (28).
  • FSH levelsFSH levels: Dandi Tablet (DDT), a traditional Chinese medicine (TCM) formula including prepared rehmannia root 24g, dogwood fruit 9g, Poria 9g, water-plantain 9g, tuber peony bark 9g, Chinese yam 12g, and red sage 15g, has been shown to significantly decrease FSH levels in postmenopausal women (13).
  • HematocritHematocrit: In clinical study, both intravenous injection of 100% Paeonia lactiflora 5mL daily and a one time pulmonary artery injection of 100% Paeonia lactiflora 5mL has resulted in statistically significant improvements in the hematocrit (11).
  • HIV viral titersHIV viral titers: The methanol extract of Paeonia suffruticosa has demonstrated strong inhibition of HIV-I integrase activity in vitro and may be a rich source of anti-HIV compounds (21).
  • Impedance cardiogramImpedance cardiogram: In clinical study, both intravenous injection and pulmonary artery injection of 100% Paeonia lactiflora 5mL has resulted in statistically significant improvements in the impedance cardiogram (Q-B, B-Y interval and Q-B/B-Y ratio, cardiac output) (11).
  • INRINR: Wong et al. reported a case of easy gum bleeding, epistaxis, and skin bruising with an international normalized ratio (INR) >6.0 in a 61 year-old man who was previously stable on warfarin therapy (27).
  • Liver biopsyLiver biopsy: A "heavy dosage" of Radix Paeonia rubra has been shown to promote the reabsorption of collagen fibers and arrest the development of liver fibrosis in patients with chronic active hepatitis and patients with chronic active hepatits with liver fibrosis (10).
  • Lung functionLung function: Patients taking the herbal formula Qingre Huoxue recipe (QHR, decoction of oldenlandia herb 30g, honeysuckle stem 30g, violet herb 30g, red peony root 15g, rehmannia root 15g, solomonseal rhizome 15g, asiabell root 30g, red sage root 30g, prepared rhubarb 12g, and giant-hyssop herb 12g) once daily in conjunction with pharmaceutical drugs for the treatment of mid-advanced crescentic nephritis showed statistically significant improvements in renal function (vs. the control group taking drugs only) after three months of treatment (6).
  • PheopneumogramPheopneumogram: IV and pulmonary artery injection with 100% Paeonia lactiflora resulted in significant improvements in the pheopneumogram in patients with pulmonary heart disease (11).
  • Progesterone levelsProgesterone levels: In a case series trial with 20 young Japanese women, Toki-shakuyaku-san, a traditional Chinese herbal prescription (consisting of peony root, atractylodes lancea rhizome, alisma rhizome, hoelen, cnidium rhizome, and Japanese angelica root) has been shown to improve low plasma progesterone levels (5). Unkei-to (a traditional Japanese herbal medicine consisting of Shakuyaku (Paeonia radix, Paeonia lactiflora Pallas) and Keihi (Cinnamomi cortex, Cinnamomum cassia Blume) has been shown to have stimulatory effects on the ovulatory process and the hypothalamic-pituitary axis in human granulosa cells in vitro (28).
  • Triglyceride levelsTriglyceride levels: Dandi Tablet (DDT), a traditional Chinese medicine (TCM) formula including prepared rehmannia root 24g, dogwood fruit 9g, Poria 9g, water-plantain 9g, tuber peony bark 9g, Chinese yam 12g, and red sage 15g, has been shown to significantly decrease triglyceride levels in postmenopausal women (13).
  • Tumor markersTumor markers: A dose of 15g daily of Ninjin Yoei To (NYT; Ren-Shen-Yang-Rong-Tang (Chinese), Kotaro Pharmaceutical Co., Ltd., Osaka, Japan) was administered to an elderly patient with lung carcinoma and after seven weeks, there was a decrease in CEA and CA19-9 (tumor marker) levels (32).